All patients seen for ART treatment should be assessed for alcohol and other drug use as part of lifestyle assessment. Alcohol use should raise concern if more that 5 units of alcohol are used per week; ideally patients should be advised to stop drinking if possible. Use of other drugs should raise concern, the common drugs used/abused in this context being cannabis in its marihuana form, inhalants (amongst adolescents), khat, heroin and to a lesser extent cocaine. For both alcohol and other drug use, concern is raised due to the disinhibiting effects of use that inhibit HIV/AIDS risk reduction plans implementation, effects on immune status (alcohol and cannabis), and as potential barriers to adherence. Heroin and free-based cocaine use has the additional transmission risk through un-sterile needles for intravenous drug users.
In patients with alcohol and drug use problems, these should be addressed in counseling sessions.